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Inherent in illness and hospitalisation are many stressors, which manifest themselves in patient responses including physiological signs of sympathetic nervous system activation and psychological distress that necessitates treatment with pharmacological agents. A wide range of medical conditions combined with exposure to the unique environmental circumstances of the intensive care unit elicit problematic patient behaviour patterns requiring the application of physical and/or use of chemical restraints. Patient responses to stress experienced as a result of illness and hospitalisation may have deleterious effects, potentially exacerbating pathological conditions and increasing the complexity and decreasing the cost effectiveness of nursing care.
TYPE OF EVIDENCE USED
Evidence of the beneficial effects of music on the physiological, psychological, and social reaction of the patient was derived from an extensive literature review. Historical sources provided observations relating to the calming and healing effects of music from such diverse sources as Pythagoras, biblical commentary, and treatises from students of the 19th century Philadelphia physician Benjamin Rush. The notes of Florence Nightingale reveal the early interest of nurses in music as a beneficial intervention. Music therapy, which emerged as a distinct discipline in the 19th century, provides a rich source of evidence for music as an auxiliary treatment for the reduction of stress, pain, and anxiety. Medical and nursing literature provided many research and observational studies confirming the belief that music intervention is an appropriate adjunct for relief of symptoms that interfere with the healing process. Research has found that heart rate, respiratory rate, and anxiety are reduced after music sessions in mechanically ventilated patients. Studies demonstrate that music reduces agitation in confused patients, improves mood, and facilitates communication. Research supports the use of music as a pain reduction tool both in cancer and post-surgical patients. In one study of patients with chronic obstructive airway disease, dyspnoea and anxiety scores showed a significant decrease after music intervention. Procedure related anxiety also demonstrated improvement with music intervention according to a study of patients undergoing flexible sigmoidoscopy. Other articles described the benefits derived from using music therapy either to benefit neonates or to reduce non-adaptive behaviours in patients with Alzheimer’s disease.
METHOD USED TO OBTAIN AND REVIEW EVIDENCE
Information obtained from a systematic review of >50 relevant research articles was synthesised into a computer database and critically analysed. Communication was initiated with other evidence-based resources, such as hospital facilities utilising music for therapeutic purposes. Queries regarding pre-existing clinical standards, along with programme design, development, implementation, evaluation, and the ultimate efficacy of their programme were initiated.
PLANNED STRATEGY FOR IMPROVEMENT
The strategy planned to achieve improvement of patient wellbeing made the documented benefits of music intervention available to all patients in the intensive care unit.
HOW THE STRATEGY WAS IMPLEMENTED
Personal compact disc players, speakers, or headphones, and a wide selection of compact discs representing the broad age spectrum and rich ethnic and cultural diversity of the surrounding community were made available for all patients to use in the intensive care unit.
METHOD OF EVALUATION
A quality improvement pilot study was designed to look at select patient parameters, which then was used to evaluate the efficacy of the music intervention project. Blood pressure, heart rate, respiratory rate, sedation and pain scale scores, medication administration, and the presence of physical restraints were recorded on a data collection sheet before and after the music intervention session. Initial data were obtained within 30 minutes prior to initiating a music intervention session and collected within 30 minutes after the completion of a music session. Demographic data, length of stay, and patient satisfaction scores, when available, were also recorded on the data collection form. Information was entered into a computer database, collated, and analysed for parameter outcomes.
Data analysed from the music intervention quality improvement pilot study of 44 patients correlate with findings in the research literature. Of the 44 patients studied, 23 demonstrated a decrease in heart rate after a music session. Respiratory rates in 24 of the patients studied decreased after a music session. Of the 13 patients able to rate their pain, 23% of those studied reported a decrease in pain after listening to music. Sedation scale scores for 16% of patients in the study demonstrated movement toward the midpoint rating of 3, which describes the patient as calm and cooperative. Of 8 patients in physical restraints upon initiation of music, 2 had their restraints removed after administration of music. Patient and family anecdotes demonstrated widespread satisfaction with the music intervention project.
Utilising a best practice model that incorporates organisational and continual quality monitoring of the music intervention project established a framework that successfully translated evidence into practice. Through the use of music intervention, staff nurses were able to creatively address problems and initiate change in daily clinical practice within the hospital setting by implementing evidence-based quality improvement strategies.
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